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Thareja J, Minj A, Samal P, Panigrahi PK. Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India. Indian J Ophthalmol 2024; 72:659-663. [PMID: 38189493 PMCID: PMC11168555 DOI: 10.4103/ijo.ijo_815_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. METHODS This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. RESULTS A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. CONCLUSION Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.
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Affiliation(s)
- Japesh Thareja
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Anita Minj
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Priyanka Samal
- Department of Haematology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be) University, 8-Kalinga Nagar, Bhubaneswar, Odisha, India
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Zhirov AL, Kolenko OV, Zhazybaev RS, Sorokin EL. [Terson syndrome and acute myeloid leukemia (case report)]. Vestn Oftalmol 2024; 140:72-78. [PMID: 38450469 DOI: 10.17116/oftalma202414001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease in vision in both eyes. Spontaneous subarachnoid hemorrhage occurred secondary to acute myeloid leukemia. Uncorrected visual acuity (UCVA) amounted to OD=0.01, OS=0.005. The anterior segment was normal in both eyes, voluminous immobile white-gray mass measuring 7-9 DD that completely covered the macula (intense hyperechoic cell suspension with a volume of about 1/2 of the vitreous cavity, ultrasound B-scan) were visualized in the posterior pole of the vitreous body of both eyes under conditions of maximum drug-induced mydriasis. Diagnosis: vitreous hemorrhage due to subarachnoid hemorrhage in both eyes secondary to acute myeloid leukemia. Vitrectomy was performed in both eyes. UCVA increased to 0.05 in both eyes. Vitrectomy contributed to improvement of visual functions and patient quality of life.
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Affiliation(s)
- A L Zhirov
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MINK "Eye Microsurgery", Khabarovsk, Russia
| | - O V Kolenko
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MINK "Eye Microsurgery", Khabarovsk, Russia
- Postgraduate Institute for Public Health Specialists, Khabarovsk, Russia
- Far-Eastern State Medical University, Khabarovsk, Russia
| | - R S Zhazybaev
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MINK "Eye Microsurgery", Khabarovsk, Russia
| | - E L Sorokin
- Khabarovsk branch of S.N. Fedorov National Medical Research Center "MINK "Eye Microsurgery", Khabarovsk, Russia
- Far-Eastern State Medical University, Khabarovsk, Russia
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Paez-Escamilla M, Caplash S, Kalra G, Odden J, Price D, Marroquin OC, Koscumb S, Commiskey P, Indermill C, Finkelstein J, Gushchin AG, Coca A, Friberg TR, Eller AW, Gallagher DS, Harwick JC, Waxman EL, Chhablani J, Bonhomme G, Prensky C, Anetakis AJ, Martel JN, Massicotte E, Ores R, Girmens JF, Pearce TM, Sahel JA, Dansingani K, Westcott M, Errera MH. Challenges in posterior uveitis-tips and tricks for the retina specialist. J Ophthalmic Inflamm Infect 2023; 13:35. [PMID: 37589912 PMCID: PMC10435440 DOI: 10.1186/s12348-023-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/07/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE Posterior uveitis is a common chorioretinal pathology affecting all ages worldwide and is a frequent reason for referral to the retina clinic. The spectrum of etiologies for uveitis is very broad and includes infectious and auto-immune diseases. Inflammation can be confined to the eye or may be a part of systemic disease. A useful outline is therefore proposed to aid in the correct diagnosis of these challenging entities. The situation is further complicated by the fact that many neoplastic conditions resemble features of posterior uveitis; they are known as "masqueraders of uveitis". Here, we summarize different posterior uveitides that present with rare findings, along with masqueraders that can be difficult to distinguish. These conditions pose a diagnostic dilemma resulting in delay in treatment because of diagnostic uncertainty. METHODS An extensive literature search was performed on the MEDLINE/PUBMED, EBSCO and Cochrane CENTRAL databases from January 1985 to January 2022 for original studies and reviews of predetermined diagnoses that include posterior uveitic entities, panuveitis and masquerade syndromes. RESULTS We described conditions that can present as mimickers of posterior uveitis (i.e., immune check-points inhibitors and Vogt-Koyanagi-Harada-like uveitis; leukemia and lymphoma associated posterior uveitis), inflammatory conditions that present as mimickers of retinal diseases (i.e., Purtscher-like retinopathy as a presentation of systemic lupus erythematosus; central serous chorioretinopathy masquerading inflammatory exudative retinal detachment), and uveitic conditions with rare and diagnostically challenging etiologies (i.e., paradoxical inflammatory effects of anti-TNF-α; post vaccination uveitis; ocular inflammation after intravitreal injection of antiangiogenic drugs). CONCLUSION This review of unique posterior uveitis cases highlights the overlapping features of posterior uveitis (paradoxical inflammatory effects of anti -TNF α and uveitis; Purtscher-like retinopathy as a presentation of systemic lupus erythematosus, …) and the nature of retinal conditions (ischemic ocular syndrome, or central retinal vein occlusion, amyloidosis, inherited conditions like retinitis pigmentosa, autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), etc.…) that may mimic them is represented. Careful review of past uveitis history, current medications and recent vaccinations, detailed examination of signs of past or present inflammation, eventually genetic testing and/ or multimodal retinal imaging (like fluorescein angiography, EDI-OCT, OCT-angiography for lupus Purtscher-like retinopathy evaluation, or ICG for central serous retinopathy, or retinal amyloid angiopathy) may aid in correct diagnosis.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gagan Kalra
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick Commiskey
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jerome Finkelstein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna G Gushchin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andreea Coca
- Department of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Thomas R Friberg
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jean C Harwick
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evan L Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gabrielle Bonhomme
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alexander J Anetakis
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erika Massicotte
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Raphaelle Ores
- Department of Ophthalmology, McGill University Campus Outaouais, Gatineau, QC, Canada
| | | | - Thomas M Pearce
- Division of Neuropathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kunal Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mark Westcott
- Department of Uveitis, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Eye Center, University of Pittsburgh School of Medicine, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Yang L, Chen Y, Zhang Y, Shen T, Shen X. Changes in retinal circulation and choroidal thickness in patients with acute myeloid leukemia detected by optical coherence tomography angiography. Front Med (Lausanne) 2023; 10:1117204. [PMID: 36993797 PMCID: PMC10041655 DOI: 10.3389/fmed.2023.1117204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
PurposeTo investigate changes in retinal circulation and the choroid in patients with acute myeloid leukemia (AML) in the acute and remission stages, to analyze the correlation between retinal circulation and laboratory parameters, and to assess risk factors associated with leukemic retinopathy.MethodsForty-eight patients (93 eyes) with AML were enrolled and divided into two groups according to fundus examination findings: the retinopathy and no retinopathy groups. Patients underwent eye measurements before treatment and after remission. Macular vessel density (VD), perfusion density (PD), foveal avascular zone (FAZ), and choroidal thickness (ChT) were measured using optical coherence tomography angiography. Patients with healthy eyes were recruited as control participants.ResultsPatients with leukemic retinopathy had higher measurements of white blood cells (WBCs), circulating blasts, fibrin degradation products, and cross-linked fibrin degradation products (D-dimer) and a lower hemoglobin (HB) count (p < 0.05). In the acute phase of the disease, the VD and PD were lower and the ChT was thicker in patients with AML than in controls (p < 0.05), irrespective of the presence of leukemic retinopathy; however, the patients were partially recovered in the remission stage. The VD was lower in patients with higher WBC (r = −0.217, p = 0.036), D-dimer (r = −0.279, p = 0.001), fasting blood glucose (FBG) (r = −0.298, p = 0.004) and triglyceride (r = −0.336, p = 0.001) levels. The FAZ area was negatively correlated with HB (r = −0.258, p = 0.012).ConclusionPatients with AML appear to have subclinical retinal perfusion loss and choroidal thickening in the acute phase of the disease, but this is reversible. Injury to bone marrow function may cause a decrease in retinal perfusion. Leukemic retinopathy is associated with abnormal hematologic parameters and coagulopathy.
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Affiliation(s)
- Ling Yang
- Department of Ophthalmology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanwei Chen
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunxiang Zhang
- Department of Hematology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Shen
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ting Shen,
| | - Xi Shen
- Department of Ophthalmology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Ophthalmology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Xi Shen,
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Sayadi J, Gouider D, Allouche Y, Choura R, Cherni I, Sayadi M, Benneji H, Zghal I, Malek I, Nacef L. Ophthalmic Manifestations of Newly Diagnosed Acute Leukemia Patients in a Tunisian Cohort. Clin Ophthalmol 2022; 16:3425-3435. [PMID: 36249442 PMCID: PMC9560867 DOI: 10.2147/opth.s365648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To describe ocular manifestations of acute leukemia in a Tunisian cohort and to assess the associations between ophthalmic findings and epidemiological, clinical, and biological features of the disease. Methods A prospective study included patients newly diagnosed with acute leukemia referred to our clinics between January 2019 and July 2020. All patients underwent a complete ophthalmic evaluation and spectral-domain optical coherence tomography (SD-OCT) at presentation, then every two months during one year. We defined two groups: Group 1 included patients with leukemic ophthalmopathy and group 2 included patients with normal ophthalmic examination. Results Forty-six patients were enrolled. The mean age of patients was 32.1±15.3 years. The sex ratio M/F was 1.55 (28 male patients and 18 females). Twenty-nine patients (63%) had acute myeloid leukemia (AML), and 17 (37%) had acute lymphoblastic leukemia (ALL). The average follow-up was 9.1 months (range: 3–12 months). We observed ophthalmic manifestations in 28 patients (61%). Among them, 17 (61%) had vision-threatening complications. The posterior segment was the most common site of ocular involvement (82% of group1). Primary leukemic infiltration (Disc edema, ptosis, exophthalmos) was present in 13 eyes (14.1%). Twenty-seven eyes (29.3%) had secondary involvement lesions (Subconjunctival hemorrhage, periorbital ecchymosis, retinal/sub-hyaloid hemorrhage, dilated/tortuous veins). Twenty-one eyes (22.8%) showed other ocular manifestations which etiopathogenesis is not yet fully understood (White-centred hemorrhages, cotton-wool spots, serous retinal detachment, hemorrhagic pigment epithelial detachment). Leukemic retinopathy was significantly more frequent in adults (23/39 and 1/7 in adult and pediatric groups, respectively; p=0.003). Patients suffering from AML were more likely to have secondary ocular involvement (20/29 and 7/17 in AML and ALL patients, respectively; p=0.047). Retinal hemorrhages were statistically associated with anemia and thrombocytopenia (p=0.041 and p=0.034; respectively). Conclusion Leukemic ophthalmopathy seems to be frequent and may lead to severe visual impairment. An ophthalmic assessment complemented with SD-OCT has paramount importance in all newly diagnosed acute leukemic patients.
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Affiliation(s)
- Jihene Sayadi
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Dhouha Gouider
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,Correspondence: Dhouha Gouider, Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Bab Saadoun, Tunis, Tunisia, Tel +21640660114, Email
| | - Yasmine Allouche
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Racem Choura
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Cherni
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Malek Sayadi
- Department of Hematology, Aziza Othmana Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hend Benneji
- Department of Hematology, Aziza Othmana Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imene Zghal
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Malek
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Nacef
- Department A, Hedi Raies Institute of Ophthalmology, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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El Salloukh NA, Hage DG, Bashshur AZ, Kheir WJ. Early Ophthalmological Manifestations of Acute Myeloid Leukemia: Current Perspectives. Clin Ophthalmol 2022; 16:2119-2127. [PMID: 35800672 PMCID: PMC9255417 DOI: 10.2147/opth.s342720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematological malignancy affecting different organ systems including the eye. The purpose of this review is to present and evaluate the medical literature regarding the early ophthalmological manifestations of acute myeloid leukemia. AML affects the ocular system through direct infiltration of tissues, secondary to hematological abnormalities, or in the form of chloroma or myeloid sarcoma in the brain or orbit consequently leading to a variety of manifestations depending on the ocular tissue involved. It is imperative for ophthalmologists to be aware of the early ophthalmological manifestations of AML which will allow for earlier diagnosis and treatment of this life-threatening disease.
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Affiliation(s)
| | - Dany G Hage
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Anna Z Bashshur
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha Jurdi Kheir
- Ophthalmology Department, American University of Beirut Medical Center, Beirut, Lebanon
- Correspondence: Wajiha Jurdi Kheir, Department of Ophthalmology, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon, Tel +961-1-350000, Fax +961-1-370837, Email
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Benvenuto F, Sgroi M, Guillen SS, Ancona D, Fandiño A. Ocular findings in children with acute leukemia at a tertiary care center in South America. Oman J Ophthalmol 2022; 15:159-162. [PMID: 35937734 PMCID: PMC9351958 DOI: 10.4103/ojo.ojo_347_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate ophthalmological findings in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in a Latin American population. MATERIALS AND METHODS This was a single-center, retrospective study. The observational analysis was conducted in AML and ALL patients seen as a routine examination at the department of ophthalmology of tertiary care center in Argentina between March 1, 2017, and February 28, 2018. RESULTS Overall, 137 patients with acute leukemia were included. The mean age was 7.9 ± 5.2 years (0-18), and 55% were male (n = 75) and 45% female (n = 45). At least one-fifth (n = 31) of the patients presented some type of ocular manifestation (23%). The most frequently observed manifestation was retinal hemorrhages (n = 14), followed by papilledema (n = 9) and ocular surface involvement (n = 5). The eye involvement was more frequently identified in the AML group (24%), compared to the ALL group (22%), especially papilledema with central nervous system compromise ALL (5%) and AML (11%), P < 0.01. The presence of hemorrhages was similar in both groups. In patients with retinal hemorrhage (n = 14), the mean hematological findings were hemoglobin 7.4 ± 0.4 g/dL (6.5-8.0), erythrocytes 2.5M ± 0.3/mm3 (confidence interval [CI], 2.0-3.1), and platelets 76,000 ± 32,000/mm3 (CI, 8000-384,000). Patients without retinal findings (n = 123), the mean hematological findings were hemoglobin 9.1 ± 0.6 g/dL (8.0-10.2), erythrocytes 3.2M ± 0.6/mm3 (CI, 2.5-3.5), and platelets 92,000 ± 44,000/mm3 (CI, 42.000-390.000). Multivariable analysis found that hemoglobin levels were the most reliable predictive factor for retinal findings. It was observed that the risk diminishes in patients with levels higher than 8.5 g/dL, and that it increased in patients with levels ranging between 6.5 and 7.5 g/dL at least twice (P < 0.01). CONCLUSIONS Our results show that ocular involvement occurs in a high percentage of patients with leukemia with a clear clinical, humoral, and sometimes prognostic correlation, suggesting routine ophthalmologic evaluation in these patients.
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Affiliation(s)
- Franco Benvenuto
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina,Address for correspondence: Dr. Franco Benvenuto, Pediatric Hospital Dr. Prof. JP Garrahan, Pichinchan 1850, ZIP 1245, Buenos Aires, Argentina. E-mail:
| | - Mariana Sgroi
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
| | - Soledad S Guillen
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
| | - David Ancona
- Department of Ocular Oncolology, Tecnologico de Monterrey, Hospital Zambrano-Hellion, Monterrey, México
| | - Adriana Fandiño
- Department of Ophthalmology, SAMIC Pediatric Hospital “Prof. Dr. JP Garrahan”, Buenos Aires, Argentina
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Hersi RM, Aldosari AM, Naaman NK, Alrajhi RK, Alqahtani AS. Bilateral Papilledema and Right Esotropia as an Initial Presentation of Acute Myeloid Leukemia in a Young Girl. Cureus 2022; 14:e25413. [PMID: 35774669 PMCID: PMC9236691 DOI: 10.7759/cureus.25413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/05/2022] Open
Abstract
Leukemia is a malignant hematologic neoplastic disease in which acquired mutations and genetic abnormalities in early hematopoietic precursors cause rapid proliferation of white blood cells (WBC). Acute myeloid leukemia (AML), a subtype of leukemia, is a rare form of cancer that typically manifests in adulthood. Symptoms typically arise due to abnormal proliferation of WBC. Ocular manifestations of such malignancies are rare and they occur more commonly in acute lymphoblastic leukemia (ALL) rather than AML. Furthermore, ophthalmic involvement usually is either a sign of central nervous system involvement or disease relapse. In this article, we report the case of a 14-year-old girl who presented initially with double vision and right eye squint. The patient was later diagnosed with AML with leptomeningeal involvement.
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Mirshahi R, Ghassemi F, Koochakzadeh L, Faranoush M, Ghomi Z, Mehrvar A, Mousavi SA, Safaee Nodehi SR. Ocular Manifestations of Newly Diagnosed Acute Leukemia Patients. J Curr Ophthalmol 2022; 34:100-105. [PMID: 35620369 PMCID: PMC9128435 DOI: 10.4103/joco.joco_10_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To present primary ocular manifestations in acute leukemia. Methods This cross-sectional descriptive hospital-based study evaluated all newly diagnosed leukemia patients of three referral hospitals of Tehran University of Medical Sciences in 2015-2016 and Mahak Hospital in Tehran in 2017. Exclusion criteria included the patients with the previous history of chemotherapy, cases of relapsing disease, and the patients with a history of ocular disease or other systemic conditions with ophthalmic manifestations. Results A total of 85 patients (170 eyes) were evaluated in our study, including 29 children (34.1%) and 43 females (50.6%). The mean patient age was 37.84 ± 11.91 years in the adult group and 6.28 ± 4.70 years in the pediatric category. Ophthalmic involvement was seen in 27 patients (31.8%), including 6 pediatric patients (20.7%) and 21 adult patients (37.5%). Two patients (2.3%) had direct infiltration by leukemic cells and 76 patients (89.41%) of patients were asymptomatic. There was a correlation between ophthalmic involvement and platelet count and hemoglobin level. In patients with ocular signs, higher mortality rates were observed. Conclusions At the time of diagnosis in acute leukemia patients, complete ophthalmic evaluation including dilated fundus examination is suggested as ocular involvement in these patients is common and sometimes asymptomatic. Ophthalmic involvement in leukemic patients should be identified in a timely manner, particularly in individuals with low platelet counts and hemoglobin levels, due to the potential prognostic relevance.
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Affiliation(s)
- Reza Mirshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leili Koochakzadeh
- Department of Pediatrics, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghomi
- Department of Radiology, Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center, MAHAK Hospital, Tehran, Iran
| | - Seyed Asadollah Mousavi
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Reza Safaee Nodehi
- Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Imam Khomeini Hospital Complex, Tehran, Iran
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Orbital Swelling and Ptosis as an Initial Presentation of Childhood Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature. Case Rep Pediatr 2021; 2021:5587767. [PMID: 34123451 PMCID: PMC8189805 DOI: 10.1155/2021/5587767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
We are reporting the case of a 3-year-old-girl who initially presented with unilateral eyelid swelling and ptosis. A diagnosis of acute lymphoblastic leukaemia (ALL) was eventually made based on an orbital incisional biopsy and a bone marrow examination. Historically, orbital involvement had been linked to myeloid leukaemia; however, in lymphoid leukaemia, they are increasingly being implicated and had been reported as the sole presentation of the disease. These findings stress the importance of conducting ophthalmologic assessments in cases diagnosed with ALL in order to prevent delays in proper assessment and treatment. Management options in orbital disease are fortunately not significantly different than well-established treatment protocols.
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Cote-Olijnyk M, Fowlkes S, Assouline S. Chronic myelogenous leukemia presenting as central retinal vein occlusion. Leuk Lymphoma 2020; 61:2515-2518. [DOI: 10.1080/10428194.2020.1775203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Sabrina Fowlkes
- Department of Medicine, Division of Hematology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Sarit Assouline
- Department of Medicine, Division of Hematology, Jewish General Hospital, McGill University, Montreal, Canada
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Acute lymphocytic leukemia masquerading as acute retinal necrosis. Am J Ophthalmol Case Rep 2020; 18:100629. [PMID: 32258824 PMCID: PMC7125310 DOI: 10.1016/j.ajoc.2020.100629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/13/2019] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of B-cell acute lymphocytic leukemia (ALL) relapse presenting as acute retinal necrosis. Observations An 11-year old boy with history of B-cell ALL undergoing maintenance therapy presented with a three-month history of intermittent blurry vision and pain in the right eye when a routine lumbar puncture indicated an elevated lymphoblast-predominant white blood cell count. Bone marrow biopsy revealed 42% lymphoblasts, confirming ALL relapse. Ophthalmic imaging demonstrated a hyperemic optic disc, retinal whitening, perivascular sheathing, retinal hemorrhages, and retinal detachment in the right eye. Vitreous fluid biopsy revealed presence of rare atypical lymphoblasts. Chemotherapy, orbital radiation, and systemic prednisone resulted in improvement of visual acuity and retinal hemorrhages, and resolution of retinal detachment. Conclusions and importance We have described the clinical features, treatment, and response in a case of B-cell ALL relapse with presenting signs of acute retinal necrosis. The uncommon finding in B-cell ALL highlights the possibility of intraocular involvement and the importance of routine ophthalmologic evaluation in leukemia remission.
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Uhr JH, Thau A, Chung C, Zhang XC. Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia. Cureus 2020; 12:e6666. [PMID: 32089973 PMCID: PMC7021241 DOI: 10.7759/cureus.6666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Simultaneous bilateral central retinal vein occlusion (CRVO) is a rare presentation that warrants consideration of an underlying hyperviscosity state. Increased serum viscosity can lead to the hematologic emergency of leukostasis with resultant vascular obstruction and hypoxic tissue damage. The following case demonstrates the first case of bilateral CRVO in a young adult secondary to acute lymphoblastic leukemia (ALL). A 23-year-old female presented to the emergency department (ED) with two days of worsening bilateral blurry vision and bitemporal headache. Her ocular exam was significant for bilateral intraretinal hemorrhages consistent with CRVO with chest radiograph demonstrating widened mediastinum with perihilar lymphadenopathy and serologic testing revealing ALL with blast crisis. The patient was subsequently admitted to the oncology service for induction chemotherapy. Patients with new headache and bilateral vision changes should prompt a thorough neurological and ophthalmologic exam to assess for underlying systemic pathologies. Concurrent bilateral CRVO is a rare but specific finding for systemic hyperviscosity syndrome, blood dyscrasia, polycythemia, or other serious illness. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality.
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Affiliation(s)
- Joshua H Uhr
- Ophthalmology, Wills Eye Hospital, Philadelphia, USA
| | - Avrey Thau
- Ophthalmology, Sidney Kimmel Medical College, Philadelphia, USA
| | | | - Xiao Chi Zhang
- Emergency Medicine, Thomas Jefferson University, Philadelphia, USA
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Ilo OT, Adenekan AO, Alabi AS, Onakoya AO, Aribaba OT, Kehinde MO, Salako O. Ocular manifestations of leukaemia: A teaching hospital experience. Niger Postgrad Med J 2019; 26:205-210. [PMID: 31621659 DOI: 10.4103/npmj.npmj_50_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. Aim This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. Patients and Methods This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012-January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. Results A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Conclusion Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.
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Affiliation(s)
| | - Adetunji O Adenekan
- Department of Ophthalmology, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Adeola O Onakoya
- Department of Ophthalmology, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Omolola Salako
- Department of Radiation Oncology, Lagos University Teaching Hospital, Lagos, Nigeria
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Halu A, De Domenico M, Arenas A, Sharma A. The multiplex network of human diseases. NPJ Syst Biol Appl 2019; 5:15. [PMID: 31044086 PMCID: PMC6478736 DOI: 10.1038/s41540-019-0092-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 02/21/2019] [Indexed: 12/11/2022] Open
Abstract
Untangling the complex interplay between phenotype and genotype is crucial to the effective characterization and subtyping of diseases. Here we build and analyze the multiplex network of 779 human diseases, which consists of a genotype-based layer and a phenotype-based layer. We show that diseases with common genetic constituents tend to share symptoms, and uncover how phenotype information helps boost genotype information. Moreover, we offer a flexible classification of diseases that considers their molecular underpinnings alongside their clinical manifestations. We detect cohesive groups of diseases that have high intra-group similarity at both the molecular and the phenotypic level. Inspecting these disease communities, we demonstrate the underlying pathways that connect diseases mechanistically. We observe monogenic disorders grouped together with complex diseases for which they increase the risk factor. We propose potentially new disease associations that arise as a unique feature of the information flow within and across the two layers.
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Affiliation(s)
- Arda Halu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Manlio De Domenico
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Alex Arenas
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Amitabh Sharma
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
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Hafeez MU, Ali MH, Najib N, Ayub MH, Shafi K, Munir M, Butt NH. Ophthalmic Manifestations of Acute Leukemia. Cureus 2019; 11:e3837. [PMID: 30891378 PMCID: PMC6411336 DOI: 10.7759/cureus.3837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Ocular involvement in leukemia may occur because of direct leukemic infiltration or because of secondary ophthalmic involvement as a result of abnormalities related to blood like anemia, thrombocytopenia, and leukocytosis. In some patients with leukemia, ophthalmic signs can precede the systemic features and can help in early diagnosis of systemic leukemia. Due to the scarcity of data on this topic from Pakistan, we conducted this study to determine the pattern of ocular involvement in patients with leukemia presenting in our settings. Methods This cross-sectional study was conducted in a tertiary care hospital of Pakistan over a period of one year. The study comprised of both newly diagnosed and follow-up patients of acute leukemia of age more than 15 years. Patients underwent detailed ophthalmic anterior and dilated posterior segment examination. Patient's demographic profile, type of leukemia, chemotherapy status, and hematologic findings were also documented. Results There were 97 leukemic patients in the study with 55 (56.7%) males and 42 (43.3%) females. Various ophthalmic manifestations were observed in 47 (48.45%) patients. Forty-two (43.3%) were diagnosed cases with acute lymphocytic leukemia (ALL) and 55 (56.7%) suffered from acute myelogenous leukemia (AML). Ophthalmic manifestations were present in 29 patients of AML (52.7%) and 18 patients of ALL (42.85%). Ocular involvement was significantly more common in newly diagnosed (n=32) as compared with follow-up patients (n=15) (p-value = 0.032). Posterior segment (n=48) was the most common site of ocular involvement (n=48, 49.5%) with retinal hemorrhages seen in 40 patients (41.2%) and papilloedema in seven cases (7.2%). Thirty-three (70.2%) out of 47 patients with ophthalmic manifestations were asymptomatic while 14 (29.8%) had ocular symptoms at the time of initial presentation. Conclusion Ophthalmic manifestations were present in about half of the patients with leukemia. Ocular involvement was more prevalent in newly diagnosed cases and in patients with AML.
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Affiliation(s)
- Mohammad Uzair Hafeez
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, University of California at Los Angeles/ Stein Eye Institute, Los Angeles, USA
| | - Nimra Najib
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Muhammad Hammad Ayub
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Kaleem Shafi
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Mubashar Munir
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
| | - Nadeem Hafeez Butt
- Department of Ophthalmology, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK
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Mukherjee C, Al-Fahad Q, Elsherbiny S. The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review. Ther Adv Ophthalmol 2019; 11:2515841419831155. [PMID: 30923793 PMCID: PMC6431765 DOI: 10.1177/2515841419831155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.
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Affiliation(s)
| | - Qusay Al-Fahad
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
| | - Samer Elsherbiny
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
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Bilateral Conjunctival Infiltration as an Extramedullary Relapse of AML. Case Rep Hematol 2018; 2018:9590469. [PMID: 29619260 PMCID: PMC5829340 DOI: 10.1155/2018/9590469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 12/25/2017] [Indexed: 12/01/2022] Open
Abstract
Acute myelogenous leukemia (AML) accounts for 1.2% of all cancer deaths. Relapse is the major cause of treatment failure in acute myeloid leukemia (AML) patients. AML rarely presents as ocular manifestation in relapse or at presentation. The M4 subtype of AML is most commonly presented with extramedullary involvement. In this report, we presented a young female with AML who was diagnosed and treated for AML about 40 months ago. She did not transplant because she did not have a full-match donor. About 4 months ago, she visited with a red eye and conjunctival infiltration. She was referred to an ophthalmologist for a biopsy, and the pathology report showed the relapse of AML which was treated with systemic chemotherapy. Red eyes with subconjunctival nodules in patients with a history of previous AML should raise the suspicion for recurrent disease that warrants urgent biopsy and systemic treatment. Eye involvement with leukemia is usually responsive to systemic chemotherapy.
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Soman S, Kasturi N, Srinivasan R, Vinod KV. Ocular Manifestations in Leukemias and Their Correlation with Hematologic Parameters at a Tertiary Care Setting in South India. Ophthalmol Retina 2018; 2:17-23. [PMID: 31047297 DOI: 10.1016/j.oret.2017.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the prevalence of ocular manifestations and the association of these manifestations with hematologic parameters among patients with leukemia attending a hemato-oncology unit at a tertiary care government hospital in South India. DESIGN This was a cross-sectional observational study. PARTICIPANTS All patients attending a hemato-oncology unit at a tertiary care government hospital in South India who were diagnosed with acute or chronic leukemia that was confirmed by a bone marrow biopsy. METHODS Consecutive patients with leukemia presenting at the hematology clinic underwent standardized leukemia blood workup and comprehensive ophthalmic evaluation. Patient demographics, the type of leukemia, ophthalmic features, and hematological parameters such as hemoglobin level, white blood cell count, and platelet counts were recorded. The association between ophthalmic manifestations and blood counts was analyzed using multivariable regression analysis. MAIN OUTCOME MEASURES The study measured the prevalence of various ocular manifestations in different types of leukemias and their association with hematologic parameters. RESULTS In total, 133 eyes of 133 patients were examined during the study period. The prevalence of leukemic ophthalmopathy was found to be 68% in cases of acute myeloid leukemia, 42% in cases of acute lymphoid leukemia, 33% in cases of chronic lymphoid leukemia, and 13% in cases of chronic myeloid leukemia. Vision-threatening complications such as subhyaloid hemorrhage involving the posterior pole (20%) and vitreous hemorrhage (10%) were seen exclusively in patients with acute leukemias. Multivariable logistic regression after adjusting for the type of leukemia, patient age, and white blood cell and platelet counts showed that the hemoglobin level was the only factor predictive of developing subhyaloid hemorrhage (every 1-g/L increment increase in hemoglobin level led to a 30% reduction in the likelihood of developing subhyaloid hemorrhage; 95% confidence interval 0.5-0.9; P = 0.02). The probability of developing subhyaloid hemorrhage was reduced by >50% when hemoglobin level improved from 5 to 7 g/L and when platelet count improved from 10 000 to 50 000 cells/mm3 for both types of acute leukemia. There was no association between white blood cell counts and ophthalmic manifestations. CONCLUSION Leukemic ophthalmopathy is more common in acute and myeloid cases and less common in chronic and lymphoid subtypes. It is predominantly due to secondary rheological changes. Blood transfusion should be considered when hemoglobin level and platelet count decrease below 7 g/L and 50 000 cells/mm3, respectively, to prevent vision-threatening complications. Patients with acute leukemias should undergo ophthalmic screening at baseline and then periodically to prevent visual morbidity.
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Affiliation(s)
- Savya Soman
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - Nirupama Kasturi
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India.
| | - Renuka Srinivasan
- Department of Ophthalmology, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
| | - K V Vinod
- Department of General Medicine, Jawaharlal Postgraduate Medical Education and Research, Puducherry, India
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Dhasmana R, Prakash A, Gupta N, Verma SK. Ocular manifestations in leukemia and myeloproliferative disorders and their association with hematological parameters. Ann Afr Med 2017; 15:97-103. [PMID: 27549412 PMCID: PMC5402809 DOI: 10.4103/1596-3519.188887] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: To study the ocular manifestations in patients diagnosed with leukemia or myeloproliferative disorders and to derive an association between the ocular manifestations and hematological parameters of the patients. Materials and Methods: This observational and descriptive study was conducted in a Tertiary Care Center of Dehradun, North India over a period of 1 year. All the diagnosed cases of leukemia and myeloproliferative diseases attending the Oncology Department were included. Patients underwent a detailed ocular examination. The hematological parameters were also recorded including hemoglobin (Hb), total leukocyte count (TLC), and platelet count. Results: The study included 102 patients out of which, there were 66 males (64.7%), and 36 were females (35.3%) with an age range of 5–80 years. A total of forty patients showed ocular manifestations (39.3%). Extraocular manifestations were seen in 10.8% patients while intraocular manifestations were noted in 45.1% patients of acute leukemia and 7.7% patients of chronic leukemia. These ocular manifestations showed a significant association with low Hb (P = 0.000), raised TLC (P = 0.004), and low platelet count (P = 0.000). The most common ocular manifestation was intraretinal hemorrhages followed by roth spots. Among acute myeloid leukemia patients (23.5%), the presence of intraretinal hemorrhages was significantly associated with low Hb (Mann–Whitney U-test = 25.000, P = 0.007). The patients of acute lymphoblastic leukemia (25.4%) showed significant association between intraretinal hemorrhages and low platelet count (Mann–Whitney U-test = 44.000, P = 0.046) and roth spots with low Hb (Mann–Whitney U-test = 11.000, P = 0.000). Ocular manifestations were more commonly seen in acute leukemias as compared to chronic leukemias. Conclusion: Ocular examination is recommended in all leukemic patients as ocular manifestations may go unnoticed, most patients being asymptomatic and could be an early sign of worsening of disease.
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Affiliation(s)
- Renu Dhasmana
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Amrita Prakash
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neeti Gupta
- Department of Ophthalmology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - S K Verma
- Department of Medicine, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Koshy J, John MJ, Thomas S, Kaur G, Batra N, Xavier WJ. Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India. Indian J Ophthalmol 2016; 63:659-64. [PMID: 26576524 PMCID: PMC4687193 DOI: 10.4103/0301-4738.169789] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context: Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. Aims: This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Settings and Design: Subjects of leukemia presenting to a tertiary care center in India. Subjects and Methods: A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. Statistical Analysis Used: The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Conclusions: Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.
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Affiliation(s)
- Jacob Koshy
- Department of Ophthalmology, Christian Medical College, Ludhiana, Punjab, India
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Khaja WA, Pogrebniak AE, Bolling JP. Combined orbital proptosis and exudative retinal detachment as initial manifestations of acute myeloid leukemia. J AAPOS 2015; 19:479-82. [PMID: 26486038 DOI: 10.1016/j.jaapos.2015.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
We report bilateral orbital and choroidal involvement as the presenting sign of acute myeloid leukemia in a 2-year-old white girl. The patient presented with painless proptosis and subconjunctival hemorrhage. Ophthalmic examination and magnetic resonance imaging revealed bilateral leukemic infiltrates of the orbits and choroid, with an exudative retinal detachment in the right eye. Bone marrow biopsy confirmed acute myeloid leukemia. Following radiation treatment, chemotherapy, and hematopoietic stem cell transplantation, the patient was doing well 12 months after presentation. Outcomes can be poor, even with treatment; prompt recognition of ophthalmic manifestations of leukemia, including proptosis, choroidal infiltration, and retinal detachment, is necessary.
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Affiliation(s)
- Wassia A Khaja
- Department of Ophthalmology, University of Florida, College of Medicine, Jacksonville, Florida
| | | | - James P Bolling
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida
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Ophthalmic manifestations in recently diagnosed childhood leukemia. Eur J Ophthalmol 2015; 26:88-91. [PMID: 26165325 DOI: 10.5301/ejo.5000647] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence and the pattern of ocular involvement in children with leukemia at the time of diagnosis. METHODS The data of patients with leukemia who underwent complete ophthalmic examination at the time of diagnosis between January 2005 and December 2014 were retrospectively reviewed. Demographic data, type of leukemia, ocular findings, blood parameters, and duration of follow-up were analyzed. RESULTS A total of 185 patients (111 male and 74 female) were included in the study, with a median age of 6.0 years (range 0.5-18.0 years) and a median follow-up time of 36.0 months (range 0.5-108.0 months). Ocular signs were present in 24.3% of the patients at the time of diagnosis and 37.8% of them were symptomatic. The prevalence of ocular involvement was 20.4% in patients with acute lymphocytic leukemia (ALL) and 36.4% in patients with acute myelocytic leukemia (AML) (p = 0.051). Fatality rate was significantly higher in subjects with AML compared with ALL (p = 0.019), but was not significantly different between patients with and without ocular involvement (p = 0.166). There were no significant differences in hemoglobin levels, white blood cell counts, or platelet counts between patients with ALL and AML. Platelet counts were significantly lower in patients with ocular signs compared with subjects without ocular involvement (p = 0.012), while hemoglobin levels and white blood cell counts did not differ significantly. CONCLUSIONS Various ocular signs may be present at the time of diagnosis in childhood leukemia, even in patients without any symptoms. Routine ophthalmic examination should be performed in recently diagnosed children with leukemia.
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Abstract
PURPOSE To investigate whether retinal nerve fiber layer (RNFL) thickness is decreased in patients with hematologic malignancy using optical coherence tomography (OCT). PATIENTS AND METHODS This prospective, observational cross-sectional study included 65 eyes from 34 patients with hematologic malignancy and 72 healthy control eyes. OCT-measured RNFL thickness parameters (average, 4 quadrants, and 12 clock-hour thickness) and RNFL defect in red-free photo were compared between patients with hematologic malignancy and controls. RESULTS Among average, quadrant, and clock-hour map, the only 11-o'clock RNFL in patients with hematologic malignancy was statistically thinner than in controls (P=0.021). The RNFL defect was detected in 21/65 (32.3%) patients with hematologic malignancy and in 5/72 (6.9%) controls (P<0.001). In patients with hematologic malignancy, the mean RNFL thickness was significantly lower in the severe and moderate anemia groups compared with the mild anemia group (P=0.011). In the generalized estimating equations model, the mean hemoglobin level was associated with RNFL thickness while correcting for inter-eye correlation, age, and refraction error (coefficient=3.685, P=0.006). CONCLUSIONS The RNFL defect was frequently observed, and the RNFL was thinner in severe anemic patients with hematologic malignancy. These results suggest that chronic anemia may be a factor of RNFL loss.
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Adejoh SO, Temilola OM, Olayiwola B. Living with cancer: a qualitative report of the experiences of leukaemia patients in Lagos, Nigeria. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:762-769. [PMID: 23925785 DOI: 10.1007/s13187-013-0524-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The study examined the qualitative, cognitive and psychosocial experiences of those living with leukaemia undergoing treatment at a teaching hospital. Twenty respondents who consented to participate were purposively selected from the cancer patients with leukaemia receiving treatment in the said teaching hospital. The in-depth interview method was used to collect data. The data was analysed using manual content analysis. Data showed that patients lack basic knowledge about leukaemia and had no beliefs regarding leukaemia. Some patients believed in God and a medical breakthrough for a cure, while for some, the hope of living was not certain. The ill-health condition had brought about financial predicament to both patients and family members and has limited their productivity in terms of income-generating activities. Good interpersonal relationships and support from their care providers aided their compliance to treatment regime and provided hope for living positively with their condition. The study concludes that there is a need to educate the patients on the causes of their condition. Financial supports should be rendered to those living with leukaemia, while health care providers should be encouraged to continue to maintain good interpersonal relationships with their patients.
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Chalam K, Patel CJ, Edwards J, Murthy RK. T-cell leukemia. Ophthalmology 2012; 119:1713-1714.e1. [PMID: 22858027 DOI: 10.1016/j.ophtha.2012.03.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 03/26/2012] [Indexed: 11/17/2022] Open
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